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Ridership for MTS Access, which provides service for seniors and the disabled, has risen sharply over the last three years. The rising use and cost of the service reveal some of the larger challenges facing San Diego as it figures out how its growing senior population will get around.

There is one group whose public transit use in San Diego County keeps rising.

San Diego’s Metropolitan Transit System saw an overall loss in transit riders of more than 4 percent last year, but MTS Access, its paratransit service that provides service for people with disabilities, has seen an increase in ridership of 33 percent over the past three years.

The sharp rise is tied to the region’s growing elderly population. Aging is highly correlated with increases in disabilities and other health issues that can make driving and taking regular buses and trolleys more difficult.

The problem is that the service is extremely expensive. The smaller buses essentially take people from door to door, costing the agency upwards of $30 per trip, compared with $1.51 per passenger if they use the fixed-route system.

In response, MTS has changed the way it determines people’s eligibility for the service.

In December, MTS decided to conduct in-person interviews with everyone who applies to use the paratransit service before signing off. Before, a would-be Access rider could get through the process with an application, a doctor’s sign-off and a phone call.

The decision concerns advocates and Access users.

“I hope people aren’t just doing this to save money at the cost of people in need,” said Patrick Macintosh from the Consumer Accessible Transportation Committee, an advocacy group made up of local paratransit users, at the December hearing.

MTS said it would provide transportation for applicants to and from the interview. MTS officials also said that if someone isn’t eligible for paratransit, they would do their best to help them used the fixed-route system. For example, if someone takes Access because they use a wheelchair and there aren’t curb cuts on the way to the nearest bus stop, MTS said they could try to work with the city to fix those sidewalks.

“We are looking to improve the efficiency of the system and the economics of it,” said MTS spokesman Mark Olson. “But it also provides a greater level of clarity. It allows us to figure out how each applicant uses the system.”

Amy Kalivas, a program manager at Access to Independence, which works with seniors and people with disabilities, said people she works with are particularly concerned about the in-person interview.

“It seemed very case to case – where they live, where they would be traveling,” Kalivas said. “On the positive side, MTS is saying it will pay for people to go. But logistically for somebody who doesn’t leave their house much, it’s overwhelming.”

There are many reasons why people use paratransit.

There could be a giant hill between a rider and the nearest bus stop that he or she can’t physically climb. Older buses and trolley stations might not have regular announcements or signs that direct riders with vision or hearing impairments. Alzheimer’s, dementia or mental illness can also rule out the fixed-route system for some.

Olson said that’s part of the reason why MTS opted for the in-person interview. Someone with late-stage Alzheimer’s will need paratransit all the time, but someone with a curb cut-out issue may be able to use some routes, some of the time.

The rising use and cost of Access reveal some of the larger challenges San Diego is facing in figuring out how its growing senior population will get around.

The San Diego Association of Governments has predicted that the number of people in the region who are 70 years and older will more than double in the next few decades.

This population will not only need alternative transportation increasingly as they age, but the spike in Access ridership suggests that figuring out a cost-effective way to cater to seniors and people with disabilities could be a key to increasing overall transit use in the region.

Martin Wachs, a professor at UCLA who studies senior transportation in cities, said MTS’s new policy for paratransit isn’t uncommon. It is very expensive to provide such services, but transit agencies can do other things.

“They’re putting barriers in place that result in only the most needy people using those options,” Wachs said. “They have limited resources, so they have to decide what to do. But you ultimately have to ask yourself: Is it to the benefit of our society is to put barriers up for the mobility of elderly people?”

Some cities, like Washington D.C., are eyeing ride-share services like Uber and Lyft to help offset the cost and meet the high demand for door-to-door transit services for those in need.

FACT, a nonprofit in San Diego, is trying a similar model. The organization uses a brokerage model that taps into ride shares and taxi services throughout the county. When seniors contacting FACT need a ride, the organization sees whether any of the services have drivers who are free and can bargain for them to pick up the seniors at a lower cost.

FACT grew fast shortly after it started in 2012 – so much so that the organization soon had to stop marketing its services because it didn’t have the funding to meet the demand, said Executive Director Arun Prem.

The organization now provides roughly 2,000 to 2,500 rides per month.

“We’ve been seeing a shortage in senior transportation,” Prem said. “They’re projecting very high increases, especially for older seniors, and there’s a direct correlation between that and rising demand for paratransit.”

MTS is trying some things to improve its fixed-route system for seniors and others with disabilities.

The agency has started upgrading its buses and trolleys to new low-floor models that make it easier for people with wheelchairs to get on and off. It has increased fines to up to $100 for people who don’t vacate seats reserved for the elderly and disabled. It’s been doing some outreach and travel training specifically for seniors and disabled populations at places like the Silvercrest Retirement Center, the San Diego Center for the Blind and the La Mesa Senior Expo.

Olson said that one of the problems the agency is facing is that the increase in seniors throughout the county is evenly distributed, rather than focused in certain places. That makes it more difficult to cater to their needs in a cost-effective way.

The most important thing MTS has done, he said, is lowering the age at which seniors can become eligible for extreme discounts on monthly passes, which are $18 versus the standard $72. Seniors in the San Diego region are eligible once they turn 60 – a lower age than in Los Angeles, Sacramento and the Bay Area.

Wachs, though, said he doesn’t think making it cheaper to ride the fixed-route system is the way to address the senior transportation issue.

“Agencies think they’re providing a huge service by discounting the cost,” Wachs said. “But the real issue is the service.”

While there are low-income groups among the elderly, many retirees can afford to pay full price to take public transit, Wachs said. They’re just choosing not to because it doesn’t serve their needs.

Transit agencies can both improve ridership and better facilitate the growing senior population by changing their routes, he said. Right now, public transit often focuses on providing services for work commutes – to and from job centers. Those routes may not be useful for retirees.

For example, Wachs suggested that transit agencies should focus more on providing service from suburbs – where many elderly bought their homes decades ago and remain – to medical centers.

Providing increased transit options to health facilities is something that MTS is trying to do, Olson said. The new Mid-Coast Trolley extension will serve three major health care institutions: UC San Diego Jacobs Medical Center, the VA Hospital and Scripps Healthcare.

“This growing population is a challenge that we’re working through,” Olson said.